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		<title>FICHE D'EXPERTISE ET DE COMMANDE</title>
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				<div id="layer5">
					<p class="arial24boldblue"><span color="#0000FF">FICHE D'EXPERTISE ET DE COMMANDE</span></p>
					<p><span><span class="arial36bold"><span>N°</span> </span></span><span class="bookman24">1-245 </span></p>
					<div id="layer3">
						<div id="layer4">
							<p class="arial28">erterterterter<br/>
								Agen
								,&nbsp;erter<br/>
								N° SIRET:&nbsp;wsrsdsdf<br/>
								N° TVA Intracomm.:&nbsp;xdvdfds<br/>
								MOL:&nbsp;sdfsdf<br/>
							</p>
						</div>
						<p class="bold">COORDONNEES CLIENT</p>
					</div>
				</div>
				<div id="layer2">
					<!--<p class="normal">SAS PAINTFILL &amp; CARDING France au capital 40 000€<br>
							ZAC du Chêne - Activillage : 2allées des Alisiers-69500 BRON-France<br>
							Tél :&nbsp; 04 72 37 10 78 - Fax :&nbsp; 04 72 37 96 26
							<br>
							e-mail : PAINTFILL.CARDING@wanadoo.fr
							<br>
							SIRET : 428 984 801 00020 - CODE APE 502Z -&nbsp;<br>
							TVA INTRACOMMUNAUTAIRE : FR 28 428 984 801</p>-->
					<p class="normal">SAS PAINTFILL & CARDING France au capital 40 000€<br>
ZAC du Chêne - Activillage : 2allées des Alisiers-69500 BRON-France<br>
Tél :  04 72 37 10 78 - Fax :  04 72 37 96 26<br> 
e-mail : PAINTFILL.CARDING@wanadoo.fr<br> 
SIRET : 428 984 801 00020 - CODE APE 502Z - <br>
TVA INTRACOMMUNAUTAIRE : FR 28 428 984 801</p>
					<div id="layer1">
						<table cellspacing="0" cellpadding="0" width="100%" bgcolor="white" border="0" height="100%">
							<tr>
								<td width="20%">
									<p class="bookman20">DATE EXPERTISE :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">9.2.2009</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td width="20%">
									<p class="bookman20">MARQUE-MODELE :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">Aixam</p>
								</td>
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								<td width="20%">
									<p class="bookman20">NOM EXPERT :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">Григор Григоров</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td width="20%">
									<p class="bookman20">Modèle :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">A.721</p>
								</td>
							</tr>
							<tr>
								<td width="20%">
									<p class="bookman20">NOM TECHNICIEN :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">4345</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td width="20%">
									<p class="bookman20">N° IMMAT :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">423</p>
								</td>
							</tr>
							<tr>
								<td width="20%">
									<p class="bookman20">TEL. TECHNICIEN :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">5345</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td width="20%">
									<p class="bookman20">N° CHASSIS  :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">231423423423</p>
								</td>
							</tr>
							<tr>
								<td width="20%">
									<p class="bookman20">N° EXPERTISE :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold"></p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td width="20%">
									<p class="bookman20">N° ASSURANCE :</p>
								</td>
								<td class="bookman20" width="2%"></td>
								<td class="tdDotUnderline">
									<p class="arial24bold">sdfsdfsd</p>
								</td>
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			<div id="layer7">
				<table class="bigtable" cellspacing="0" cellpadding="0" width="100%" border="0">
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						<td class="topleft" align="left" height="44">
							<p class="arial20BoldCenter">ELEMENT DE CARROSSERIE</p>
						</td>						
						<td class="topleft" colspan="4" height="44">
							<table width="100%" border="0" cellspacing="0" cellpadding="0" height="100%">
								<tr>
									<td class="right" colspan="4" align="center" valign="middle">
										<div align="center">
											<p class="arial20BoldCenter">BOSSES</p>
										</div>
									</td>
								</tr>
								<tr>
									<td class="bottom">
										<p class="arial20BoldCenter">&lt;=<br />
											10mm</p>
									</td>
									<td class="bottom">
										<p class="arial20BoldCenter">&lt;=<br />
											20mm</p>
									</td>
									<td class="bottom">
										<p class="arial20BoldCenter">&lt;=<br />
											35mm</p>
									</td>
									<td>
										<p class="arial20BoldCenter">&gt;<br />
											35mm</p>
									</td>
								</tr>
							</table>
						</td>
						<td class="topleft" align="left" width="15%" height="44">
							<p class="arial20BoldCenter">OBSERVATIONS</p>
						</td>
						<td class="topleft" width="8%" height="44">
							<p class="arial20BoldCenter">P'N'P</p>
						</td>
						<td class="topleft" width="8%" height="44">
							<p class="arial20BoldCenter">ALUMINIUM</p>
						</td>
						<td class="topleft" width="8%" height="44">
							<p class="arial20BoldCenter">DEGARNISSAGE</p>
						</td>
						<td class="topleft" width="8%" height="44">
							<p class="arial20BoldCenter">POLISSAGE</p>
						</td>
						<td class="right" width="8%" height="44">
							<p class="arial20BoldCenter">PRIX</p>
						</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Capot</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">
							<p>&nbsp;</p>
						</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Pavillon</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">0</td>
						<td class="topleft" align="center" width="6%" height="19">0</td>
						<td class="topleft" align="center" width="6%" height="19">0</td>
						<td class="topleft" align="center" width="6%" height="19">5</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">Non</td>
						<td class="topleft" align="center" width="8%" height="19">Non</td>
						<td class="topleft" align="center" width="8%" height="19">Non</td>
						<td class="topleft" align="center" width="8%" height="19">Non</td>
						<td class="topleft" align="right" width="8%" height="19">75.69  €&nbsp;&nbsp;&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Coffre</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Aile avant gauche</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Porte avant gauche</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Porte arrière gauche</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Aile arrière gauche</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Montant gauche</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Aile avant droite</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Porte avant droite</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Porte arrière droite</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="19">
						<td class="topleft" align="left" height="19">
							<p class="arial18BoldLeft">Aile arrière droite</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="19">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="19">&nbsp;</td>
					</tr>
					<tr height="18">
						<td class="topleft" align="left" height="18">
							<p class="arial18BoldLeft">Montant droit</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="18">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="18">&nbsp;</td>
					</tr>
					<tr height="18">
						<td class="topleft" align="left" height="18">
							<p class="arial18BoldLeft">Casquette</p>
						</td>						
						<td class="topleft" align="center" width="6%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="6%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="15%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="18">&nbsp;</td>
						<td class="topleft" align="center" width="8%" height="18">&nbsp;</td>
						<td class="topleft" align="right" width="8%" height="18">&nbsp;</td>
					</tr>
					<tr height="18">
						<td class="bottom" align="left" height="18" colspan=10>
							<p class="arial18BoldLeft"></p>
						</td>
						
					</tr>
				</table>
			</div>
			<div id="layer8">
				<table cellspacing="0" cellpadding="3" border="0">
					<tr height="19">
						<td nowrap="nowrap" width="154" height="19">
							<p class="arial16">PRISE EN CHARGE ACCORD CLIENT</p>
						</td>
						<td nowrap="nowrap" width="373" height="19">
							<div align="right">
								<p class="arial24"></p>
							</div>
						</td>
						<td nowrap="nowrap" width="100" height="19">
							<p class="arial28bold" align="right">0.00  €&nbsp;&nbsp;</p>
						</td>
					</tr>
					<tr height="18">
						<td colspan="2" nowrap="nowrap" width="527" height="18">
							<p class="arial22bold">Le dégarnissage est à la charge du Carding</p>
						</td>						
						<td width="100" height="18"></td>
					</tr>
					<tr height="18">
						<td nowrap="nowrap" width="154" height="18">
							<p class="arial18">VALIDATION ACCORD TARIFAIRE</p>
						</td>
						<td nowrap="nowrap" width="373" height="18">
							<p class="arial28" align="right">Prix HT :</p>
						</td>
						<td nowrap="nowrap" width="100" height="18">
							<div align="right">
								<p class="arial28bold">75.69  €&nbsp;&nbsp;</p>
							</div>
						</td>
					</tr>
					<tr height="18">
						<td width="154" height="18">
							<p class="arial16">Coefficient technicité</p>
						</td>
						<td width="373" height="18"></td>
						<td width="100" height="18">
							<div align="right">
								<p class="arial28bold">0&nbsp;&nbsp;</p>
							</div>
						</td>
					</tr>
					<tr height="17">
						<td nowrap="nowrap" width="154" height="17">
							<p class="arial16">Tarif négocié</p>
						</td>
						<td nowrap="nowrap" width="373" height="17"></td>
						<td nowrap="nowrap" width="100" height="17">
							<div align="right">
								<p class="arial28bold">0.00  €&nbsp;&nbsp;</p>
							</div>
						</td>
					</tr>
					<tr height="18">
						<td nowrap="nowrap" width="154" height="18"></td>
						<td nowrap="nowrap" width="373" height="18">
							<div align="right">
								<p class="arial28">Prix Total HT :</p>
							</div>
						</td>
						<td nowrap="nowrap" width="100" height="18">
							<p class="arial28bold" align="right">75.69  €&nbsp;&nbsp;</p>
						</td>
					</tr>
					<tr height="17">
						<td nowrap="nowrap" width="154" height="17">
							<p class="arial16">NOM DU RESPONSABLE :</p>
						</td>
						<td nowrap="nowrap" width="373" height="17">
							<p align="right"><span class="arial16">................................................................................  </span><span class="arial28">TVA : <strong>20%</strong></span></p>
						</td>
						<td nowrap="nowrap" width="100" height="17">
							<div align="right">
								<p class="arial28bold">15.14  €&nbsp;&nbsp;</p>
							</div>
						</td>
					</tr>
					<tr height="17">
						<td nowrap="nowrap" width="154" height="17">
							<p class="arial16">SIGNATURE :</p>
						</td>
						<td nowrap="nowrap" width="373" height="17">
							<p class="arial28" align="right"><strong>TVAPrix Total TTC</strong> :</p>
						</td>
						<td nowrap="nowrap" width="100" height="17">
							<div align="right">
								<p class="arial28bold">90.83  €&nbsp;&nbsp;</p>
							</div>
						</td>
					</tr>
					
					<tr height="28">
						<td nowrap="nowrap" width="154" height="28">
							<p class="arial18BoldCenterUnderlin"></p>
						</td>
						<td width="373" height="28">
							<p class="arial18BoldCenterUnderlin">Véhicule contrôlé par :</p>
						</td>
						<td align="center" valign="top" nowrap="nowrap" rowspan="3" width="100" height="86">
							<div align="center">
								<table height="70" cellspacing="0" cellpadding="0" width="98" border="0">
									<tr valign="middle" height="23%">
										<td valign="bottom" colspan="2" height="23%">
											<div align="center">
												<p class="bookman11">MODE DE PAYEMENT</p>
											</div>
										</td>
									</tr>
									<tr valign="middle" height="27%">
										<td align="right" valign="middle" width="53%" height="27%">
											<p class="bookman11" align="right">Chèque<img height="15" alt="" src="chkbox.gif" width="15" align="middle" border="0" /></p>
										</td>
										<td align="right" valign="middle" width="55%" height="27%">
											<div align="right">
												<p class="bookman11">Espèces<img height="15" alt="" src="chkbox.gif" width="15" align="middle" border="0" /></p>
											</div>
										</td>
									</tr>
									<tr valign="middle" height="27%">
												<td align="right" valign="middle" width="53%" height="27%"> <div align="right"><p class="bookman11">Virement<img height="15" alt="" src="chkbox.gif" width="15" align="middle" border="0" /></p></div></td><td align="right" valign="middle" width="55%" height="27%"><div align="right"><p class="bookman11">Autres<img height="15" alt="" src="chkbox.gif" width="15" align="middle" border="0" /></p></div></td>
									</tr>
									<tr valign="middle" height="22%">
										<td valign="middle" colspan="2" height="22%">
											<div align="center">
												<p class="bookman11">DATE DU REGLEMENT</p>
											</div>
										</td>
									</tr>
								</table>
							</div>
						</td>
					</tr>
					<tr height="19">
						<td nowrap="nowrap" width="154" height="19">
<!--							<p class="arial16">{LE} :</p> --> &nbsp;
						</td>
						<td nowrap="nowrap" width="373" height="19">
							<p class="arial16" align="left">....................................................................................................................... SIGNATURE :</p>
						</td>
					</tr>
					<tr height="27">
						<td nowrap="nowrap" width="154" height="27">&nbsp;
							<!--	<p class="arial16">NOM DU RESPONSABLE :</p> -->
						</td>
						<td nowrap="nowrap" width="373" height="27">&nbsp;
						<!-- ....................................................................................................................... --></td>
					</tr>
				</table>
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